ArticleThrombosis journal2022
Evaluation of clinical outcomes in patients treated with heparin or direct thrombin inhibitors during extracorporeal membrane oxygenation: a systematic review and meta-analysis.
Article in Thrombosis journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Anticoagulation Strategies in Adults Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.Artificial organs · 2026Pooled it
- Anticoagulant effects of nafamostat administered via central venous catheter versus the ECMO circuit in adults receiving ECMO support.Frontiers in cardiovascular medicine · 2026Article
- Alternative Anticoagulation for Patients with Heparin-Induced Thrombocytopenia on ECMO: A Narrative Review.Biomedicines · 2025Review
- Anticoagulation during extracorporeal membrane oxygenation: questioning the current standards in balancing the risks of thrombosis and bleeding.British journal of anaesthesia · 2025Article
- Between a rock and a hard place: anticoagulation management for ECMO.Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Review
- Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout.The journal of extra-corporeal technology · 2024Review
- Anticoagulation strategy with bivalirudin plus aspirin combination during extracorporeal membrane oxygenation for COVID-19-associated acute respiratory distress syndrome.Turk gogus kalp damar cerrahisi dergisi · 2024Article
- Extracorporeal Membrane Oxygenation.Respiratory care · 2023Review
- Sustaining Life versus Altering Life-Saving Drugs: Insights to Explain the Paradoxical Effect of Extracorporeal Membrane Oxygenation on Drugs.Journal of clinical medicine · 2023Review
- Current and future strategies to monitor and manage coagulation in ECMO patients.Thrombosis journal · 2023Review
- Current and future options for adult biventricular assistance: a review of literature.Frontiers in cardiovascular medicine · 2023Review
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe number of patients treated with extracorporeal membrane oxygenation (ECMO) devices is increasing. Anticoagulation therapy is crucial to prevent thrombosis during ECMO therapy. Predominantly, heparin has been used as primary anticoagulant but direct thrombin inhibitors (DTI) have been established as alternatives. The aim of this systematic review and meta-analysis was to evaluate clinical outcomes in patients treated with heparin compared to different DTI during ECMO.
methodsA systematic search was conducted. Full scientific articles were sought for inclusion if heparin anticoagulation was compared to DTI (argatroban/bivalirudin) in ECMO patients. Risk of bias was assessed by Newcastle Ottawa scale. Primary endpoint was in-hospital mortality. Bleeding events, thrombotic events, hours of ECMO support, days of hospital stay, percentage of time within therapeutic range and time to therapeutic range were extracted from full texts as secondary endpoints. Results were presented as Forrest-plots. GRADE was used for confidence assessment in outcomes.
resultsSystematic search identified 4.385 records, thereof 18 retrospective studies for a total of 1942 patients, complied with the predefined eligibility criteria:15 studies investigated bivalirudin and 3 studies investigated argatroban versus heparin. Risk of bias was high for most studies. In-hospital mortality, major bleeding events and pump-related thrombosis were less frequent in DTI group as compared to heparin [mortality-OR 0.69, 95% CI 0.54-0.86; major bleeding-OR 0.48, 95% CI 0.29-0.81; pump thrombosis-OR 0.55, 95% CI 0.40-0.76]. Additionally, percentage of time within therapeutic range was higher for DTI [SMD 0.54, 95% CI 0.14-0.94]. GRADE approach revealed a very low level of certainty for each outcome.
conclusionIn this meta-analysis, DTI and especially bivalirudin showed beneficial effects on clinical outcomes in ECMO patients as compared to heparin. However, due to the lack of randomized trials, certainty of evidence is low.
trial registrationThis systematic review and meta-analysis was prospectively registered at PROSPERO data base (reference number CRD42021237252 ).
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